Saturday, December 08, 2012

Jonathan Chait and the Goldilocks principle

by digby

Ed Kilgore wonders why many of us are so specifically hostile to Jonathan Chait over his piece yesterday endorsing raising the Medicare age and I would guess that Chait's over the top response to Dayen today will explain at least some of it. But it really is more than that. And it's more than his endorsement of Iraq, although that was pretty bad. It's his contrarian --- usually anti-left (the only way to describe it) --- take on just about everything, which often makes no sense at all. I mentioned the notorious "re-install Saddam Hussein" piece yesterday, which was inexplicably published on the pages of the LA Times. But how about this one, from just last year? It's not as if this is the first time he's made this argument.

Tom Coburn and Joe Lieberman's bipartisan plan to cut Medicare is one of those notions whose every word ("Coburn," "Lieberman," "bipartisan," etc.) seems designed to provoke liberal antagonism. Talking Points Memo calls it "Ryan Plan 2.0." Joan McCarter and Greg Sargent are attacking it as well. I think they're making a mistake.

I'm, sure Ed can see that Chait's framing of this argument is virtually designed to provoke. That's what he does.

Anyway:

First, it's just not accurate to conflate this proposal with Ryancare. Paul Ryan's Medicare plan has two huge problems. First, it privatizes Medicare, fragmenting the system into an inefficient private insurance market. Second, it provides grossly and increasingly inadequate subsidies for insurance within that system. Describing that proposal as "ending Medicare" is contestable but fair.

Coburn and Lieberman's proposal does neither of these things. It may not be perfect, but it's basically a standard package of trimming Medicare while leaving the basic structure in place. Here's Kate Pickert's handy thumbnail description:

* Raise the Medicare eligibility age from 65 to 67, which the senators acknowledge is only feasible because the Affordable Care Act makes it easier for 65 and 66-year-olds to buy private insurance.

* Institute a single Medicare deductible of $550, ask seniors to pay coinsurance for services from 5% to 20%, and set a new annual “out-of-pocket” maximum of $7,500, which will protect seniors from medical bankruptcy. (Higher income seniors will face higher “out-of-pocket” maximums, up to $22,500 for individuals earning $160-$213,000 per year.)
* Limit supplemental insurance coverage so that seniors can’t purchase Medigap policies to cover all of their out of pocket expenses. Studies show this change could reduce over-utilization without harming health.
* Stop paying hospitals for debts incurred, but not paid, by Medicare beneficiaries.
* Increase Medicare Part B premiums for all enrollees, but especially high-income earners. Increase Part D premiums for high-income earners.
* Fix the SGR for three years. This would prevent Congress from having to constantly vote to prevent Medicare reimbursements from falling dramatically.
* Combat Medicaid Medicare fraud. See here for more on this provision.

The irony here is that comparing this to Ryancare plays into Ryan's intellectual sleight of hand. Ryan argues that Medicare as it's currently structured can't continue. The only alternatives are to do nothing and watch it disappear, impose draconian bureaucratic rationing, or try his proposal.

The truth is that Medicare is in trouble, and the cost-saving measures in the Affordable Care Act are an important step toward controlling health care cost inflation but probably not enough to solve the problem on their own. Over the very long run we need to build on its cost-control devices.

In the medium-run, we probably need to impose some straightforward cost saving. Coburn/Lieberman is a way to do that while preserving the traditional Medicare system. It's proof that Ryan is wrong.

Of course liberals were going to be hostile to this idea. Just because it isn't as bad as Ryan's slash and burn approach doesn't mean it's supportable. Chait often takes this approach (what I call the "Goldilocks" style of politics) in which he positions himself as the lone true liberal struggling to find sanity in a sea of crazy leftists and kooky rightwingers. Here you have the left represented by such lefty lunatics as Joan McCarter and Josh Marshall, while the crazy right is represented by Paul Ryan. And the sane center is ... Tom Coburn and Joe Lieberman. Surely it's not hard to see why liberals might be a little bit testy when confronted with that framework.

Now in my view, Chait's a big boy who likes to mix it up or he wouldn't frame his arguments this way, so I don't think he needs to be defended from those, like Dayen, who come after him with equal vigor. That's the game he chooses to play and he plays it well. Indeed, he's made a very successful career out of it.

It's actually a testament to Kilgore's decency that he would be confused by Dave Dayen's reaction. Kilgore, you see, is the opposite of Chait although his history as a centrist might indicate otherwise. Kilgore is a mensch and a very careful writer who tries to see all sides and presents his arguments straight up without regard to where they fall on the partisan scale. I read everything he writes and have for years and quote him liberally. I am certainly further to the left than he is, but I know he is not coming to his conclusions out of a reflexive hostility to left wing ideology or a desire to categorize me as beyond the pale in order to present himself as the one true liberal. In other words, from years of reading his work and coming to understand his values, I always feel his respect and I respect him right back.

...the added cost is not the trigger for the invective; that comes from this: Raise the eligibility age and PEOPLE WILL DIE.

No, that’s not an exaggeration, and the failure of certain wonks to take that into consideration speaks to their isolation from everyday people, even the everyday people who provide services to them, such as grocery-store clerks, waitresses, and construction workers in right-to-work states. These are people who cannot wait until they’re 67 for the full complement of Medicare benefits. Many of them are people who will wind up paying the individual mandate penalty in Obamacare, because even if purchased through an exchange, the monthly premium will be more than they can afford.

Yes indeed. As I wrote yesterday, the most offensive part of Chait's argument was the one in which he says that throwing people in their 60s out of Medicare would be a good way to build support for Obamacare --- as if such a cruel political strategy was terribly clever, when it actually well .. kills people.

These are real human beings we're talking about. I'm one of them. Health care wonks who know what they're talking about understand that there are plenty of people at my age who are already getting killed in health care premiums which the calculators show aren't going to be helped all that much by the Obamacare subsidies. I've just been praying I could make it to 65. I really don't want to have to hold on any longer and tons of people in ill health are in even worse shape than I am.

And by the way, the only way this whole thing works is to have it take place quickly, no long phase-in. So it will hit people like me.